Transgenic Research Center In the Cancer Center

Service Requisition Form

ES cell manipulation for gene targeting


Which service?

Contact Data:


Date: Name:
Dept: PI:
Lab location    


Billing Account Information:

Project#  (eg, 1234567)
Task# (eg, 100)
Award (rg, ACAEH)
NCI Funded? 
Name of person who has authorization over the account: 

A-PLAC protocol #: 
Animal Housing Location: 

Construct Name (12 character limit): 

Genomic DNA background  Concentration  ng/ul
Volume ul  Selection marker
5' arm length 3' arm length
Purification method Buffer

Is Cre recombination in ES cells required? 

Project and DNA Construct Description (attach restriction map):


Special Requirements:


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